Mss-Autoimmune Diseases Of The Musculoskeletal System

Front 1

What is the primary reason everyone does not have an autoimmune disease?

Back 1

tolerance

Front 2

What are the 2 types of tolerance?

Back 2

central and peripheral

Front 3

What are 3 immunologic mechanisms of joint disease?

Back 3

t-cell activation, autoreactive antibodies, and excess ab-ag formation

Front 4

CRP is an indicator of what?

Back 4

inflammation

Front 5

Why would C3 and C4 be low in an autoimmune reaction?

Back 5

formation of complement would use them up, hence lower levels

Front 6

What is a complex autoimmune disease involving chronic, systemic, inflammation with multiple organ systems involvement?

Back 6

SLE

Front 7

What are the major immunologic features of SLE?

Back 7

1. ANA
2. Anti-ds DNA
3. Immune complex deposits in skin and kidneys

Front 8

What is a chronic, inflammatory disease of the joints with varying degrees of systemic involvement?

Back 8

RA

Front 9

What are the major immunologic features of RA?

Back 9

1. RF and anticitrulline antibody (CCP)
2. immune complexes
3. inflammatory joint infiltrate
4. 14-28% ANA +
5. HLA associations

Front 10

Who most often suffers from RA, females or males?

Back 10

females

Front 11

RF's are antibodies to what?

Back 11

Fc region of IgG antibodies

Front 12

4 of which criteria must be met to diagnose RA?

Back 12

1. morning stiffness
2. arthritis of 3 or more joints
3. arthritis of hand joints
4. symmetric arthritis
5. rheumatoid nodules
6. serum rheumatoid factor
7. radiologic changes

Front 13

Some proteins change from arginine to what? How is this related to RA?

Back 13

citruline; testing for antibodies to citrulinated peptides is more specific for RA than RF's

Front 14

What factor is indicated in nearly all pathways contributing to RA?

Back 14

TNF-alpha

Front 15

What are the main effects of TNF-alpha in RA?

Back 15

induces proliferation of pro-inflammatory cytokines (IL-1 and IL-6), helps to recruit inflammatory cells, stimulates cells to break down matrix

Front 16

What 2 cytokines play an important role in RA?

Back 16

1. TH-1 (produces INF-Gamma and TNF)
2. TH-17 (produces IL-17, which promotes IL-1 and TNF)

Front 17

What occurs in the early stages of RA?

Back 17

synovial lining begins to thicken after introduction of WBCs into joint space

Front 18

What occurs in the middle stages of RA?

Back 18

synovial membrane forms a pannus, which begins to erode into the bone itself

Front 19

What occurs in the late stages of RA?

Back 19

osteoclast activity is stimulated in joint spaces through t-cell activation of osteoclast cytokines

Front 20

What does etanercept specifically target in RA?

Back 20

TNF-alpha

Front 21

What is is a heterogeneous group of autoimmune diseases of unknown etiology, characterized by chronic arthritis, often of larger joints?

Back 21

Juvenile Rheumatoid Arthritis (JRA)

Front 22

What are the characteristics of JRA?

Back 22

1. HLA associations
2. ANA + 40% of patients
3. + RF
4. Activated CD4+ T cells

Front 23

What age group does JRA affect?

Back 23

<16 y/o

Front 24

Is JRA symmetrical or not?

Back 24

asymmetric

Front 25

What are the criteria for diagnosing JRA?

Back 25

1. <16 y/o
2. arthritis in 1 or more joints
3. persists for >6 weeks
4. type of arthritis in first 6 months (polyarthritis-5 joints, oligoarthritis-4 joints, or arthritis w/fever)
5. exclusion of other juvenile arthrites

Front 26

HLA-B27 is associated with?

Back 26

ankylosing spondylitis

Front 27

What is a chronic inflammatory disease of the sacroiliac joints, vertebrae, and entheses (insertions of tendons and muscles)

Back 27

ankylosing spondylitis

Front 28

What part of the body does ankylosing spondylitis usually affect?

Back 28

the back

Front 29

Is RF positive or negative in ankylosing spondylitis?

Back 29

negative

Front 30

Primary population affected by ankylosing spondylitis?

Back 30

young males

Front 31

"Shiny corners" on vertebral x-rays, positive Schober's test, and anterior uviitis are symptoms of what disease?

Back 31

ankylosing spondylitis

Front 32

What is the Schober's test?

Back 32

mark L5 and 10cm above when patient is standing->have patient bend over-> normal (negative) will show increased distance

Front 33

Reactive Arthritis is also called?

Back 33

Reiter’s Syndrome

Front 34

Reactive Arthritis is usually triggered by what?

Back 34

Chlamydia trachomatis, Salmonella, Shigella, Yersinia

Front 35

Reactive Arthritis shows what RF testing? HLA-B27?

Back 35

negative; positive

Front 36

Myasthenia Gravis has associations with what glandular tissue?

Back 36

thymus

Front 37

What is the primary difference between Myasthenia Gravis and Lambert-Eaton syndrome?

Back 37

Lambert-Eaton syndrome does not affect facial muscles; Myasthenia Gravis does affect facial muscles

Front 38

What 2 diseases are known as idiopathic inflammatory myopathies, characterized by lymphocytic infiltration of skeletal muscle?

Back 38

polymyositis and dermatomyositis

Front 39

What are the immunologic features of polymyositis and dermatomyositis?

Back 39

1. ANA and other auto-ab
2. Lymphocytic and plasma cell infiltrates
3. Cytotoxic lymphokine
4. Immune complexes and complement

Front 40

What are the primary muscles involved with polymyositis and dermatomyositis?

Back 40

large, proximal muscles of the extremities

Front 41

T or F: MG is associated with cancer

Back 41

true

Front 42

What are the criteria for diagnosing Polymyositis and Dermatomyositis?

Back 42

1. Proximal muscle weakness
2. Evidence of myositis from biopsy
3. Elevated enzymes in blood-CK and Aldolase
4. EMG findings of myopathy
5. Characteristic rash for DM

Front 43

What disease may present with heliotropic rash around the eyes and Gottron’s papules on fingers?

Back 43

Polymyositis and Dermatomyositis